Enhancing care for ED patients experiencing hypothermia

Práctica basada en evidencia
By:
Ayer

To treat hypothermic patients arriving at the emergency department (ED), Jeremy Hulsker, BS, RN, CEN, found an opportunity to potentially triple rewarming rates and reduce mortality.
An ED charge nurse with UCHealth Memorial Hospital Central, he pioneered the initiative to update the Accidental Hypothermia Protocol for patients admitted across UCHealth Southern Colorado Region EDs.

“The protocol was last updated in 2017, and I wanted to make sure that it aligned with the current best practices for treating accidental hypothermic patients,” said Hulsker. “The new protocol needed to include methods for assessing and treating hypothermic patients, such as the HOPE (hypothermia outcome prediction after ECLS) score, the Arctic Sun system and extracorporeal membrane oxygenation (ECMO) for profoundly hypothermic patients.”

To add ECMO to the updated protocol, Hulsker worked with the cardiothoracic team to ensure they were on board with their role in supporting profoundly hypothermic patients. With their understanding and approval, Hulsker created detailed guidelines for the use of ECMO and a protocol for notifying and activating the cardiothoracic team.

The Arctic Sun is a temperature management system often used to induce hypothermia in comatose patients following cardiac arrest or to mitigate the risk of brain injury. Through research for his UEXCEL Level III project, however, Hulsker found it capable of rewarming patients at a rate of 1.6 degrees Celsius per hour. This is an improvement compared to traditional methods at 0.5 degrees Celsius per hour.

“I confirmed with the Arctic Sun representatives that the system could be used for rewarming and worked with them to set up training for our staff on how to safely implement this new rewarming method,” said Hulsker.

Understanding that not all facilities have access to targeted-temperature management systems, Hulsker made sure staff at all facilities knew the resources they could utilize for supporting their accidental hypothermic patients.

“These updates help save hospital resources and give our hypothermic patients a better chance at survival,” he said.

The new Accidental Hypothermia Protocol was approved in January 2025 and has been implemented throughout the UCHealth Southern Colorado Region.

Sobre el autor

Robert Allen loves meeting new people and learning their stories, and he's continually inspired by the patients, staff and providers he meets at UCHealth.

A journalist for 12 years, he joined UCHealth in 2019 after reporting and editing at the Detroit Free Press. He is the author of Fading Ads of Detroit, a book exploring connections between classic Detroit brands found on ghost signs and in the personal histories of Detroit residents.

His outdoor adventures include scrambling summits, hunting powder stashes via snowboard and rafting whitewater. He earned his bachelor's degree in journalism from Oklahoma State University and MBA from Colorado State University. He lives in Windsor with his wife, Rachel, and their obstinate pug, Darla.